Is Spinal Deformity Surgery in Patients with Cerebral Palsy Truly Beneficial? A Patient/Parent Evaluation
d - Medtronic Sofamor Danek
e - Medtronic Sofamor Danek
Purpose: To evaluate the radiographic results of spinal deformity surgery in cerebral palsy (CP) patients and to determine if the patient/parent felt it was beneficial.
Methods: Neuromuscular patient evaluation questionnaires were answered retrospectively by 81 patients/family of CP children undergoing spinal fusion. The average follow-up was 4.2 years (range 2-14). The questionnaires were designed to assess patient function, pain, cosmesis, self-image, and the quality of life of the patient and parent/caregiver. Results of the questionnaires were divided into categories, graded, and analyzed. Radiographic data and complication rates were also analyzed.
Results: Overall satisfaction rate was 92%. 87% reported improvement with sitting balance, 94% with cosmesis, 51% in overall activity level, and 66% in quality of life of the patient/parent. The postoperative complication rate was 33%. The mean preoperative Cobb angle of the main curve was 86º (range 50-128º), which corrected to 33º (range 2-76º) (58% correction rate) postoperatively. The spinal coronal balance parameters of pelvic obliquity, clavicle angle, and C7 plumbline were significantly improved in all cases. (See table)
Conclusion: Despite the perioperative difficulties seen with CP patients, the overall satisfaction rate with the deformity surgery was high (92%). 87% reported improvement in sitting balance, 94% improved cosmesis, and 66% felt their quality of life had improved. The radiographic parameters of coronal balance significantly improved in all cases. Our data supports the argument that spinal deformity surgery in patients with CP significantly benefits both patient and family.
Age Mean: 15.2 yo (9-21)
|
Preoperative Mean
|
Postoperative Mean
|
P
|
% Correction Rate Mean
|
|
| Main Curve Cobb* |
85.9° (50-128)
|
35.7° (2-76)
|
6.6E-14
|
57.6% (22-96) |
| C7-CSVL* |
115.3mm (5-315)
|
53.4mm (4-162)
|
0.0001
|
|
| Pelvic Obliquity* |
23.6° (0-128)
|
6.4° (0-23)
|
0.0001
|
|
| Clavicle Angle* |
11.6° (0-40)
|
4.7° (0-16)
|
0.00032
|
|
| T5-T12 |
32.6° (-2-+90)
|
28.2° (3-67)
|
0.15494
|
|
| T10-L2 |
17.3° (-47-+61)
|
2.3° (-23-+24)
|
0.18888
|
|
| T12-S1 |
-49.6° (-41-+100)
|
-56.4° (-59-+110)
|
0.18888
|
|